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SUPREME COURT AGREES TO HEAR SAN CARLOS APACHE APPEAL ON HEALTH CARE FUNDING



Adrienne Washington Cronkite News//November 22, 2023//

Home>courts>

Supreme Court agrees to hear San Carlos Apache appeal on health care funding

Nurse Diana Weaselboy performs a checkup at Patina Wellness Center in Phoenix,
part of Native American Connections, in this 2019 file photo. The Supreme Court
agreed to hear a case from the San Carlos Apache and the Northern Arapaho Tribe
over claims that the Indian Health Service is shortchanging them on health care
reimbursements. (Photo by Ricky Cornish/Cronkite News)


SUPREME COURT AGREES TO HEAR SAN CARLOS APACHE APPEAL ON HEALTH CARE FUNDING



Adrienne Washington Cronkite News//November 22, 2023//

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The Supreme Court said this week it will consider a claim by the San Carlos
Apache tribe that the federal government is shortchanging it on funds it needs
to operate tribal health services.

The case turns on whether the Indian Health Service should reimburse the tribe’s
overhead costs for health services it delivers with the support of third-party
insurers, like Medicaid or private insurance. In the case of the San Carlos
Apache, that amounted to $3 million in overhead expenses over a three-year
period, according to court documents.

The IHS claims it already pays tribes an administrative fee to offer health
services. Requiring it to pay overhead for services paid for by a third party
would be a “sweeping” expansion of its obligations that would cut the budget for
health care for “some of the most underserved tribal communities in the
country.”



When asked for comment, IHS said it does not comment on pending litigation. But
an attorney for the tribe called the case “another effort by IHS to penalize
tribal governments trying to maximize quality health care for their communities
with extremely limited resources.”

“On two prior occasions the Supreme Court has rejected government efforts to
restrict contract support cost payments to tribes operating self-determination
contracts (Cherokee Nation and Ramah Navajo),” Lloyd Miller, the attorney, said
in a text message Monday.

The San Carlos Apache is one of two tribes, along with the Northern Arapaho
Tribe of Wyoming, suing IHS over the agency’s obligations under the Indian
Self-Determination and Education Assistance Act. Among other things, the act
allowed tribes to take over operation of health services that had been provided
by IHS.



In exchange, the IHS paid the tribes the cost of care it would otherwise have
been providing, as well as a “contract support costs” fee to cover tribes’
administrative costs.

The law also allows tribes to bill third-party insurers and keep the payments,
as long as the money goes back into tribal health care. But a lower court noted
that “there is a hole” in that plan, since tribes are stuck with the additional
cost of processing the third-party payment.

“When Tribes operate the enlarged program, they incur increased overhead
expenses, such as increased auditing and financial management costs,” the San
Carlos Apache said in their appeal to the Supreme Court. “If the government
refuses to reimburse these overhead expenses, Tribes must divert program income
away from (health care) services.”

Both parties agree that IHS is woefully underfunded, leading to “‘persistent
health disparities’ in American Indian communities.” According to documents in
the case, IHS spends $4,078 per capita, compared to $8,109 for Medicaid and
$13,185 for Medicare.

But IHS claims that forcing it to pay for third-party overhead would make things
worse by saddling the agency with additional costs estimated between $800
million and $2 billion a year.

Appeals courts in the 9th and 10th judicial circuits sided with the San Carlos
Apache and the Northern Arapaho Tribe, respectively. IHS appealed to the Supreme
Court, saying that if those rulings are allowed to stand, tribes that collect
third-party payments “would be able to significantly expand their IHS funding”
while noncontracting tribes “would likely face reduced programs or services.”

The tribes agreed with IHS that the Supreme Court should hear the case and
settle the issue, but that it should uphold the circuit courts’ decisions.

“The Tribe’s request for reimbursement of contract support costs is not a cash
grab, as the government implies,” the San Carlos Apache filing says. “Rather, it
is the Tribe’s attempt to obtain the funding it needs and deserves under the
statutes to start closing the healthcare gap.”


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Tags: Indian Self-Determination and Education Assistance Act, federal
government, Cherokee Nation, Supreme Court, private insurance, Indian Health
Service, income, tribal health services, San Carlos Apache tribe, Wyoming, Ramah
Navajo, Funds, Northern Arapaho Tribe, contract support costs, Medicaid


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SUPREME COURT AGREES TO HEAR SAN CARLOS APACHE APPEAL ON HEALTH CARE FUNDING

The Supreme Court said this week it will consider a claim by the San Carlos
Apache tribe that the fe[...]


REPORT REVEALS STRONG IMPACT OF MILITARY BASES, OPERATIONS ON EMPLOYMENT

Close to one out of every 40 jobs in the state is due to the fact that Arizona
has multiple military[...]


SOLAR PANELS WILL CUT WATER LOSS FROM CANALS IN GILA RIVER INDIAN COMMUNITY

In a move that may soon be replicated elsewhere, the Gila River Indian Community
recently signed an [...]


AN INNOVATIVE FLUSH: PHOENIX TURNS TO ARTIFICIAL INTELLIGENCE FOR IMPROVED
WASTEWATER MONITORING

From self-driving cars to automated services, artificial intelligence has been
influencing every asp[...]


BIDEN AND LÓPEZ OBRADOR SET TO MEET, WITH FENTANYL, MIGRANTS AND CUBA ON THE
U.S.-MEXICO AGENDA

President Joe Biden and Mexican President Andrés Manuel López Obrador, two
strong allies who don't[...]


ECONOMY SLOWING DOWN, JOBLESS RATE UP SLIGHTLY

The Arizona economy is slowing down. New figures Thursday from the Office of
Economic Opportunity sh[...]


BORDER ENCOUNTERS DIP SLIGHTLY, BUT TUCSON SECTOR AGAIN SAW MOST TRAFFIC

Border Patrol officers encountered 55,224 migrants in the Tucson sector in
October, far outstripping[...]


INCREASING SUPPLY OF TURKEYS DRIVES DOWN PRICE OF TRADITIONAL THANKSGIVING
CENTERPIECE

They may not be a bargain. But an increasing supply of turkeys this year is
driving down the price o[...]


SUPREME COURT AGREES TO HEAR SAN CARLOS APACHE APPEAL ON HEALTH CARE FUNDING

The Supreme Court said this week it will consider a claim by the San Carlos
Apache tribe that the fe[...]


REPORT REVEALS STRONG IMPACT OF MILITARY BASES, OPERATIONS ON EMPLOYMENT

Close to one out of every 40 jobs in the state is due to the fact that Arizona
has multiple military[...]


SOLAR PANELS WILL CUT WATER LOSS FROM CANALS IN GILA RIVER INDIAN COMMUNITY

In a move that may soon be replicated elsewhere, the Gila River Indian Community
recently signed an [...]


AN INNOVATIVE FLUSH: PHOENIX TURNS TO ARTIFICIAL INTELLIGENCE FOR IMPROVED
WASTEWATER MONITORING

From self-driving cars to automated services, artificial intelligence has been
influencing every asp[...]


BIDEN AND LÓPEZ OBRADOR SET TO MEET, WITH FENTANYL, MIGRANTS AND CUBA ON THE
U.S.-MEXICO AGENDA

President Joe Biden and Mexican President Andrés Manuel López Obrador, two
strong allies who don't[...]


ECONOMY SLOWING DOWN, JOBLESS RATE UP SLIGHTLY

The Arizona economy is slowing down. New figures Thursday from the Office of
Economic Opportunity sh[...]


BORDER ENCOUNTERS DIP SLIGHTLY, BUT TUCSON SECTOR AGAIN SAW MOST TRAFFIC

Border Patrol officers encountered 55,224 migrants in the Tucson sector in
October, far outstripping[...]


INCREASING SUPPLY OF TURKEYS DRIVES DOWN PRICE OF TRADITIONAL THANKSGIVING
CENTERPIECE

They may not be a bargain. But an increasing supply of turkeys this year is
driving down the price o[...]

Next



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